title: Fatal duodenal hemorrhage complicated after living donor liver transplantation: case report.
abstract: Fatal hemorrhage caused by duodenal ulcer is rarely seen after liver transplantation. We report a case with penetrating duodenal ulcer resulting in massive gastrointestinal tract hemorrhage from a ruptured pseudoaneurysm of the hepatic artery. The patient, a 54-year-old man, had undergone living donor liver transplantation with a graft from his son. Massive hematelnesis occurred 7 days after transplantation. Endoscopy revealed a penetrating duodenal ulcer. Repeated episodes of hemorrhage resulted in shock. Angiography showed a ruptured pseudoaneurysm of the proper hepatic artery. Embolization controlled the bleeding; however, the grafted liver became ischemic. The patient subsequently developed ischemic cholangitis, which was treated with percutaneous transhepatic cholangial drainage. Repeat transplantation was performed 30 months later. The patient was doing well at 10-month follow-up.
authors.affiliation: Department of Surgery, China Medical University and China Medical University Hospital, Taichung, Taiwan, China.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lee
authors.forename: L-B
authors.initials: LB
authors.lastname: Jeng
authors.forename: K-S
authors.initials: KS
authors.lastname: Poon
authors.forename: Y-F
authors.initials: YF
authors.lastname: Chen
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Ho
authors.forename: H-C
authors.initials: HC
authors.lastname: Lai
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging*; D006396:Hematemesis; D019694:Hepatitis B, Chronic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D012086:Reoperation; D012422:Rupture, Spontaneous; D016896:Treatment Outcome